Instrument for Manual Insertion of a Button

ABSTRACT

A button inserter includes a shaft having a fulcrum that extends beyond a distal tip of the shaft. An inner rod is within the shaft and has a button mating surface that extends from a distal tip of the inner rod. A handle includes a handle switch that translates the inner rod between an extended position where the button mating surface of the inner rod extends beyond the distal tip of the shaft and a retracted position where the button mating surface of the inner rod is located completely within the shaft.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.15/278,804, filed Sep. 28, 2016, the entire contents of each of whichare incorporated herein by reference in its entirety for all purposes.

BACKGROUND

A button inserter is employed to pass a button construct through adrilled bone tunnel for positioning and deployment of the button on thecortex of a bone. Typically, pull-through sutures and needle arerequired to advance a suture button through a bone tunnel and fordeployment of the button onto the distal cortical surface of the bone.The use of pull-through sutures and needle requires the perforation ofthe periosteum and soft-tissue adjacent to the exit plane of the bonetunnel, commonly referred to as an “inside-out” technique. The use ofpull-through sutures and needle associated with an “inside-out”technique can cause a surgeon to advance the suture button farther thannecessary to deploy and flip the button into its position on the bonecortex. Advancing the device farther than necessary may also causesoft-tissue to become trapped underneath the button when seated on thebone cortex resulting in the button being positioned proud on the bonesurface.

SUMMARY

A button inserter includes a shaft and an inner rod within the shaft.The inner rod has a button mating surface that extends from a distal tipof the inner rod and engages a button. A handle includes a handle switchthat translates the inner rod between a first position and a secondposition. The button inserter is used to position the button beyond abone, and the inner shaft translates from the first position to thesecond position to release the button from the end of the buttoninserter, allowing the button to flip.

In an embodiment, a button inserter includes a shaft having a fulcrumthat extends beyond a distal tip of the shaft. An inner rod is withinthe shaft and has a button mating surface that extends from a distal tipof the inner rod. A handle includes a handle switch that translates theinner rod between an extended position where the button mating surfaceof the inner rod extends beyond and communicates with the distal buttonmating surface of the shaft and a retracted position where the buttonmating surface of the inner rod is located completely within the shaft.

In another embodiment, the handle includes a resilient member and aslide both located inside the handle. The resilient member moves theslide away from a distal end of the handle to retract the inner rod whenthe handle switch is released.

In another embodiment, a surgical system includes a button inserter. Thebutton inserter includes a shaft including a fulcrum that extends from adistal tip of the shaft and an inner rod within the shaft that has abutton mating surface that extends from a distal tip of the inner rod.The button inserter includes a handle including a handle switch thattranslates the inner rod between an extended position where the buttonmating surface of the inner rod extends beyond the distal end of theshaft and a retracted position where the button mating surface of theinner rod is completely within the shaft. An oblong button includes acongruent mating surface to the button mating surface of the inner rodof the button inserter. When the oblong button is attached to theinserter in the extended position, the oblong button is constrainedrotationally and translationally by the fulcrum of the shaft and thebutton matting surface on the inner rod of the inserter. A suture strandpasses through an opening of the oblong button.

In another embodiment, the surgical system includes a second button.

In another embodiment, the handle includes a groove and a pair ofresilient arms, and the second button is located in the groove andsecured to the handle by the pair of resilient arms.

In another embodiment, the oblong button is substantially parallel to alongitudinal axis of the shaft in the initial position, and the secondbutton is substantially perpendicular to the longitudinal axis of theshaft in a deployed position.

In another embodiment, the second button is a round button. In anotherembodiment, the suture strand passes through an opening of the secondbutton.

In another embodiment, the suture strand imparts an off-axis tensileforce between the oblong button and the second button.

In another embodiment, a surgical method includes the steps of insertingan oblong button into a bone tunnel. The oblong button is mated to abutton inserter. The button inserter includes a shaft including afulcrum that extends from a distal tip of the shaft, an inner rod withinthe shaft having a button mating surface extending from a distal tip ofthe inner rod, and a handle including a handle switch. The handle switchtranslates the inner rod between an extended position where the buttonmating surface of the inner rod extends beyond the distal end of theshaft and a retracted position where the button mating surface of theinner rod is completely within the shaft. The method includes the stepsof releasing the handle switch and retracting the button matting surfaceinto the shaft of the button inserter to allow rotational motion about atransverse axis of the oblong button. In an embodiment, the oblongbutton is secured against the bone surface, and the inserter iswithdrawn through the bone tunnel.

In an embodiment according, a bone tunnel can be in any short, long, orirregular bone. In another embodiment, the bone tunnel is through atibia, fibula, or both tibia and fibula. For example, a system asdisclosed herein can be used for ankle syndesmosis with or withoutassociated ankle fracture repair.

In another embodiment, the oblong button rests against a medial cortexof a bone.

In another embodiment, the bone is a tibia.

In another embodiment, a second button is positioned against a lateralside of a bone.

In another embodiment, the second button is positioned against a lateralside of a second bone.

In another embodiment, a second button is positioned against a boneplate.

In another embodiment, the second button is a round button. In anotherembodiment according, the second button is a dog bone shaped button.

These and other features of the present invention can be best understoodfrom the following specification and drawings, the following of which isa brief description

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a side cross-sectional view of a button inserter usedto insert a distal button through a drilled passage in a bone;

FIG. 2 illustrates an expanded view of the button inserter;

FIG. 3 illustrates a perspective view of the button inserter;

FIG. 4 illustrates a top view of a round button in a handle of theinstrument;

FIG. 5 illustrates a side view of a shaft including an inner rod thatengages the oblong button;

FIG. 6 illustrates a perspective exploded view of the shaft, the innerrod, and the oblong button; and

FIG. 7 illustrates a fulcrum of the button inserter at a distal end ofthe shaft.

DETAILED DESCRIPTION

FIGS. 1 to 3 illustrate a suture button inserter 10 used to manuallyinsert an oblong button 12 through a drilled bone tunnel. The suturebutton inserter 10 includes a handle 14, a shaft 16, and an inner rod 18located inside the shaft 16. The inner rod 18 includes a button matingsurface, which extends beyond the distal tip of the shaft 16. When theinner rod 18 is deployed, the inner rod 18 can translate relative to theshaft 16 to position the button mating surface inside the shaft 16. Thehandle 14 includes a handle switch 20 and a suture strand 22 that issecured and wrapped around the handle switch 20. When the handle switch20 is released, a resilient member 30 (for example, a spring) locatedbetween a cap 32 (located at a proximal end of the handle 14) and aslide 34 (located inside the handle 14) moves the slide 34 away from adistal end of the handle 14. The slide 34 translates the inner rod 18through the shaft 16 from the extended position to a retracted position.In one example, a proximal end of the inner rod 18 is received in anopening in the slide 34. When in the extended position, the handleswitch 20 is received in an opening 36 in the slide 34 to preventmovement of the slide 34 and therefore the inner rod 18.

As shown in FIG. 4 , the handle 14 includes a groove 38, and a roundbutton 24 is located within the groove 38. A pair of resilient arms 44retain the round button 24 to the handle 14. The round button 24 issubstantially perpendicular to a longitudinal axis X of the shaft 16. Inone example, the round button 24 may be other shapes (e.g., dog bone oroblong).

As shown in FIGS. 5 to 6 , a distal end of the shaft 16 includes afulcrum 40 that extends beyond a distal tip 46 of the shaft 16. In theextended position, the button mating surface of the inner rod 18 extendsbeyond the distal tip 46 of the shaft 16. When the oblong button 12 isattached to the button inserter 10 in the extended position, the oblongbutton 12 is constrained rotationally and translationally by the fulcrum40 of the shaft 16 and the button matting surface on the inner rod 18 ofthe button inserter 10. The inner rod 18 has a button mating surfacethat extends from a distal tip 48 of the inner rod 18. The button matingsurface of the inner rod 18 engages a congruent mating surface of theoblong button 12.

When the inner rod 18 moves to the retracted position, the button matingsurface of the inner rod 18 is located completely within the shaft 16.The oblong button 12 flips to a deployed position about the fulcrum 40of the shaft 16. In one example, the deployed position is substantiallyperpendicular to the initial position.

In one example, the inner rod 18 is received in an opening (not shown)of the oblong button 12 and retains the oblong button 12 to the buttoninserter 10. In one example, the oblong button 12 is substantiallyparallel to the longitudinal axis X of the shaft 16 when in an initialposition. In the initial position, the oblong button 12 is rotationallyand translationally constrained. The oblong button 12 includes aproximal opening 26, a distal opening 28, and a channel 27 that islocated between the proximal opening 26 and the distal opening 28. Thesuture strand 22 passes through the proximal opening 26 of the oblongbutton 12. The suture strand 22 also extends through an opening 42 inthe round button 24 and is wrapped around the handle switch 20. Theoblong button 12 and the round button 24 can be made of stainless steel,titanium alloy, titanium, PEEK or PLLA, or any other material.

When the inner rod 18 translates relative to the shaft 16 to theretracted position, the suture strand 22 applies an off-axis tensileforce P between the oblong button 12 and the round button 24. Withoutthe button mating surface constraining movement, the oblong button 12rotates to the deployed position about the transverse axis Q at aninterface between the oblong button 12 and the fulcrum 40. The off-axisis non-parallel to the longitudinal axis.

A bone tunnel is drilled in at least one bone. In one example, a bonetunnel is drilled in a tibia, in a fibula, or in both the tibia and thefibula.

In an example, the shaft 16 of the button inserter 10 is inserted intoand through a bone tunnel in a first bone and a second bone. The oblongbutton 12 is mated to the button inserter 10. Once the oblong button 12(which is in the initial position) is located beyond the both bones, thehandle switch 20 of the handle 14 is released. The button mattingsurface of the inner rod 18 retracts into the shaft 16 of the buttoninserter 10. Due to the off-axis force P applied by the suture strand22, the oblong button 12 will rotate, or flip, about the transverse axisQ to the deployed position. In the deployed position, the oblong button12 is substantially perpendicular to the axis X of the instrument 10. Inuse, the shaft 16 prevents the oblong button 12 from traveling backthrough the bone tunnel. The round button 24 is released from the handle14. The suture strand 22 extends between the first bone and the secondbone to provide fixation.

In one example, the oblong button 12 rests against a medial cortex of abone. The second button 24 can be positioned against a lateral side ofthe bone. In another example, the oblong button 12 is positioned againstthe first bone, and the second button 24 is positioned against a lateralside of the second bone. The oblong button 12 can be positioned againstthe medial cortex of the first bone. In yet another example, the roundbutton 24 is positioned against a bone plate. Although the fixation ofbone to bone has been described, the button inserter 10 can also be usedfor the fixation of soft tissue to bone.

The button inserter 10 allows the oblong button 12 to be pushed intoposition through a bone tunnel instead of being pulled through the bonetunnel with a suture and a needle. This allows for easier deployment ofbuttons. The oblong button 12 also prevents lateral tissue entrapment.

In an embodiment, the suture strand can be a flexible material, e.g.,suture or suture tape. In another embodiment, the suture strand can bean adjustable or non-adjustable loop. In an embodiment, the combinationof the suture strand and buttons in the disclosed systems can be anadjustable, knotless button/loop construct. In an embodiment, a knotlessloop construct is self-locking.

A button inserter and a surgical system as disclosed herein can also beused in procedures for ankle syndesmosis repair and for fracturemanagement (e.g., ankle, wrist, hand, etc.). For example, a method ofankle syndesmosis repair (with or without ankle fracture) includes a)inserting an oblong button into bone tunnels traversing the tibia andfibula, wherein the oblong button is mated to a button inserter asdisclosed herein; b) releasing the handle switch, whereby the buttonmating surface retracts into the shaft of the button inserter to allowrotational motion of the button; and c) securing the oblong button onthe medial tibial cortex. The method can further include withdrawing thebutton inserter through the tibial and fibular bone tunnels. The methodcan also include adjusting a suture strand so there is no excessflexible material. The method can also include securing a second buttonagainst a bone plate on the lateral surface of the fibula. In anembodiment, the second button can be secured by tightening the suturestrand (e.g., cinching an adjustable construct). In an embodiment, thesecond button is a round button.

In an embodiment, a method includes reducing a fracture prior topreparing bone tunnels. In an embodiment, reducing the fracture includesmounting a bone plate to the fractured bone(s). In an embodiment, amethod includes reducing a fracture of the fibula prior to preparingbone tunnels through the fibula and/or tibia. In an embodiment of anklesyndesmosis repair, a method includes attaching a bone plate to a fibulaprior to repairing a bone tunnel.

The foregoing description is only exemplary of the principles of theinvention. Many modifications and variations are possible in light ofthe above teachings. It is, therefore, to be understood that within thescope of the appended claims, the invention may be practiced otherwisethan using the example embodiments which have been specificallydescribed. For that reason the following claims should be studied todetermine the true scope and content of this invention.

What is claimed is:
 1. A surgical system comprising: a) a buttoninserter comprising: i) a shaft including a projection that defines afulcrum at a distal end of the projection, wherein the projectionextends beyond a distal tip of the shaft; ii) an inner rod within theshaft having a button mating surface extending from a distal tip of theinner rod; and iii) a handle including a handle switch that translatesthe inner rod between an extended position where the button matingsurface of the inner rod extends beyond the distal tip of the shaft anda retracted position where the button mating surface of the inner rod iscompletely within the shaft; b) an oblong button including a congruentmating surface to the button mating surface of the inner rod of thebutton inserter, wherein the oblong button is constrained rotationallyand translationally by (i) the projection of the shaft that defines thefulcrum and (ii) the button mating surface on the inner rod of theinserter when the inner rod of the button inserter is in the extendedposition; c) a second button configured to be removably coupled to thehandle; and d) a suture strand passing through an opening of the oblongbutton and further passing through an opening of the second button,wherein when the inner rod translates relative to the shaft to theretracted position, the suture strand applies an off-axis force torotate the oblong button about the fulcrum from an initial position to adeployed position.
 2. The surgical system of claim 1, wherein the handleincludes a groove and a pair of resilient arms, and the second button islocated in the groove and removably coupled to the handle by the pair ofresilient arms.
 3. The surgical system of claim 1, wherein the oblongbutton is substantially parallel to a longitudinal axis of the shaft inthe initial position and the oblong button is substantiallyperpendicular to the longitudinal axis of the shaft in the deployedposition.
 4. The surgical system of claim 1, wherein the suture strandimparts an off-axis tensile force between the oblong button and thesecond button.
 5. The surgical system of claim 1, wherein the projectionis an integral, unitary, monolithic part of the shaft.
 6. The surgicalsystem of claim 1, wherein the button mating surface contacts thecongruent mating surface of the oblong button in the initial position tothereby constrain translational and rotational motion of the oblongbutton, and wherein the button mating surface does not contact theoblong button in the deployed position.
 7. The surgical system of claim1, wherein the suture strand is coupled to the handle switch.
 8. Thesurgical system of claim 1, wherein the opening of the oblong buttoncomprises a proximal opening, and wherein the oblong button furthercomprises a distal opening.
 9. The surgical system of claim 8, whereinthe oblong button further comprises a channel positioned between theproximal opening and the distal opening.
 10. The surgical system ofclaim 8, wherein the suture strand is positioned only in the proximalopening.
 11. The surgical system of claim 1, wherein the off-axis isnon-parallel to a longitudinal axis of the shaft.
 12. The surgicalsystem of claim 1, wherein the second button is a round button.
 13. Thesurgical system of claim 1, wherein the second button is oblong or a dogbone shape.
 14. The surgical system of claim 1, wherein the secondbutton is substantially perpendicular to a longitudinal axis of theshaft when the second button is removably coupled to the handle.
 15. Thesurgical system of claim 1, further comprising: a cap positioned at aproximal end of the handle; a slide positioned inside of the handle andcoupled to the inner rod; and a resilient member positioned between thecap and the slide, wherein the resilient member is configured to movethe slide away from a distal end of the handle to thereby translate theinner rod through the shaft from the extended position to the retractedposition.
 16. The surgical system of claim 15, wherein the handle switchis positioned in an opening in the slide when the inner rod is in theextended position to thereby prevent movement of the slide and the innerrod.